My Issue With Early & Aggressive Treatment Of HIV...

[rawTOP]

one more thing to add, RT: when u say that drug toxicities may appear 20-40 years down the line, that is actually at least double the life expectancy of most people who are HIV+ and NOT on treatment. what the medical community has proven beyond all doubt is that, when using current therapies, starting treatment when t-cells fall below 200 extends survival time and improves health substantially less than when one starts treatment when their t-cells fall below 350. furthermore, the medical consensus has emerged in US and elsewhere that the same relationship applies to starting when t-cells fall below 500 as opposed to 350 (earlier is better). what remains controversial is whether the medical community should wait until the results of the START Trial b4 making a decision on whether to advise starting treatment when t-cells exceed 500.

so let me ask u, RT: if tomorrow u were told that u have 600 t-cells and HIV-1 infection, at what point would YOU choose to go on meds? what's ur threshold?

look at what i've said... it's hardly tin foil hat wearing sorta stuff... i say people should go on meds when they need them. you're 200/350/500+ question is exactly where the debate should be. thing is, meds from day 1 no matter what your t-cell count is, seems to be where policy is going. that scares the shit out of me. and now with PrEP they're trying to give meds to people who aren't even poz. what happened to "first, do no harm"? i mean PrEP completely violates that principle. these aren't asprin they're telling guys to take (hell, even asprin can be dangerous)...

to answer your question if it were me, i'd take meds starting when my t-cell count consistently dropped below 500, but before it consistently got down to 350. but that would be after i saw how things stabilized - from what i've heard things bounce around a bit the first 6 to 12 months. and when i would go on meds i'd take as few meds as possible, and go for the mildest ones that work on whatever strain i had. i wouldn't shoot for absolute zero viral load - i'd be happy enough with "détente" - just enough meds so my t-cells stay good and things are generally in balance. if i'm a bit above detectable that would be fine with me (though i'd do more research to make sure that's not a bad choice).

overly aggressive medicine isn't something that's theoretical for me. for 22 years i was told i had a brain tumor and doctors had me on meds to stop seizures that were supposedly caused by the tumor. the meds fucked with my gums pretty badly - still have problems in that respect. the doctors did very dangerous biopsies to figure out the type of tumor but refused to believe the results of the biopsies - that it was just scar tissue. i don't have a brain tumor - never did. and i don't have seizures - never did. i have a scar that was caused when i fell and hit my head on concrete steps when i was a kid in summer camp. and i have vasovagal reactions to things - pretty simple blackouts. it was all quite clear when you look at the records but i was essentially lied to by doctors for years and years - and they were some of the top doctors in their field - some of them were quite senior at memorial sloan kettering. i knew the MSKCC doctors were full of shit - i knew my body. but it took me years before i could find doctors who were willing to go against the MSKCC diagnosis.

it goes further... when my lover died of aids in '95 his social worker said "you know, his doctor is really well respected and he's at all the conferences giving papers, etc. but a lot of his patients die whereas the doctors who are less well known and aren't as aggressive in their treatments - their patients tend to live".

those experiences, and what i've seen of the pharmaceutical marketing business scares the shit out of me when i see doctors treat aggressively. there are certain forms of cancer where aggressive treatment is called for - but beyond that the less weird shit you put in your body, the better... [i'm not big on recreational drug use either...]

the other thing is that i had to deal with my own mortality pretty young. they told me i had a brain tumor when i was 18. the next few years were an emotional roller coaster but as the years went on i became less afraid of death. in that whole process i learned to focus on the quality of life rather than the quantity of life. it's not about how long i live. it's about accomplishing something and enjoying the journey - no matter how long or short that journey is.

treating people aggressively is usually focused on the quantity of life, not the quality of life - it's the wrong objective. and as wrong objectives often do, i predict it will backfire and the people who treated their hiv aggressively will live shorter lives as the drug side effects start damaging their bodies. i came to peace with "my brain tumor" and when i see poz guys, the ones i respect the most are the ones who've come to peace with their hiv. hiv doesn't define them, they're not consumed with it, and they're not trying to eradicate every trace of it from their bodies. they may even embrace it. their lives are about other things - they just go on living, they don't ignore their medical needs, but they're ok with a moderate approach to things.

what i'm advocating isn't hardly in the category of tin foil hat - it's about finding a middle road - everything in moderation... but you have to be at peace with things to be ok with that sort of approach. i understand how some people just aren't in that mindset. i saw it in my boyfriend that died. being poz destroyed him emotionally to the point where he'd take toxic doses of herbal remedies. i had to lock all of the pills he bought at the health food store away in a cabinet - they were hurting him. he never did come to peace with being poz and i think it was a big reason why he didn't survive. he wanted the aggressive treatment - but that aggressive treatment killed him. if he could have just been at peace with things and taken things more slowly and calmly he might still be alive - it was only a year later when ARVs came onto the scene... but slowly and calmly just seems wrong when you're in the middle of what you think is a crisis - often it's only later that you understand it was the right approach.

[Guest Porthos]

Let me see...Rawtop says don't start meds too early, my Doctor says start right away....mmmmm? not sure who I should listen too.

[TonyRedux]

look at what i've said... it's hardly tin foil hat wearing sorta stuff... i say people should go on meds when they need them. you're 200/350/500+ question is exactly where the debate should be. thing is, meds from day 1 no matter what your t-cell count is, seems to be where policy is going. that scares the shit out of me. and now with PrEP they're trying to give meds to people who aren't even poz. what happened to "first, do no harm"? i mean PrEP completely violates that principle. these aren't asprin they're telling guys to take (hell, even asprin can be dangerous)...

to answer your question if it were me, i'd take meds starting when my t-cell count consistently dropped below 500, but before it consistently got down to 350. but that would be after i saw how things stabilized - from what i've heard things bounce around a bit the first 6 to 12 months. and when i would go on meds i'd take as few meds as possible, and go for the mildest ones that work on whatever strain i had. i wouldn't shoot for absolute zero viral load - i'd be happy enough with "détente" - just enough meds so my t-cells stay good and things are generally in balance. if i'm a bit above detectable that would be fine with me (though i'd do more research to make sure that's not a bad choice).

overly aggressive medicine isn't something that's theoretical for me. for 22 years i was told i had a brain tumor and doctors had me on meds to stop seizures that were supposedly caused by the tumor. the meds fucked with my gums pretty badly - still have problems in that respect. the doctors did very dangerous biopsies to figure out the type of tumor but refused to believe the results of the biopsies - that it was just scar tissue. i don't have a brain tumor - never did. and i don't have seizures - never did. i have a scar that was caused when i fell and hit my head on concrete steps when i was a kid in summer camp. and i have vasovagal reactions to things - pretty simple blackouts. it was all quite clear when you look at the records but i was essentially lied to by doctors for years and years - and they were some of the top doctors in their field - some of them were quite senior at memorial sloan kettering. i knew the MSKCC doctors were full of shit - i knew my body. but it took me years before i could find doctors who were willing to go against the MSKCC diagnosis.

it goes further... when my lover died of aids in '95 his social worker said "you know, his doctor is really well respected and he's at all the conferences giving papers, etc. but a lot of his patients die whereas the doctors who are less well known and aren't as aggressive in their treatments - their patients tend to live".

those experiences, and what i've seen of the pharmaceutical marketing business scares the shit out of me when i see doctors treat aggressively. there are certain forms of cancer where aggressive treatment is called for - but beyond that the less weird shit you put in your body, the better... [i'm not big on recreational drug use either...]

the other thing is that i had to deal with my own mortality pretty young. they told me i had a brain tumor when i was 18. the next few years were an emotional roller coaster but as the years went on i became less afraid of death. in that whole process i learned to focus on the quality of life rather than the quantity of life. it's not about how long i live. it's about accomplishing something and enjoying the journey - no matter how long or short that journey is.

treating people aggressively is usually focused on the quantity of life, not the quality of life - it's the wrong objective. and as wrong objectives often do, i predict it will backfire and the people who treated their hiv aggressively will live shorter lives as the drug side effects start damaging their bodies. i came to peace with "my brain tumor" and when i see poz guys, the ones i respect the most are the ones who've come to peace with their hiv. hiv doesn't define them, they're not consumed with it, and they're not trying to eradicate every trace of it from their bodies. they may even embrace it. their lives are about other things - they just go on living, they don't ignore their medical needs, but they're ok with a moderate approach to things.

what i'm advocating isn't hardly in the category of tin foil hat - it's about finding a middle road - everything in moderation... but you have to be at peace with things to be ok with that sort of approach. i understand how some people just aren't in that mindset. i saw it in my boyfriend that died. being poz destroyed him emotionally to the point where he'd take toxic doses of herbal remedies. i had to lock all of the pills he bought at the health food store away in a cabinet - they were hurting him. he never did come to peace with being poz and i think it was a big reason why he didn't survive. he wanted the aggressive treatment - but that aggressive treatment killed him. if he could have just been at peace with things and taken things more slowly and calmly he might still be alive - it was only a year later when ARVs came onto the scene... but slowly and calmly just seems wrong when you're in the middle of what you think is a crisis - often it's only later that you understand it was the right approach.

that's quite a bit to respond to just now, as i'm about to shower n hunt some ass while Boo e-surfs n watches movies. to re-clarify the 'tin-foil-hat' analogy, i distinctly said u were not there but that the particular reasoning u cited could eventually lead u there. also, u've answered one threshold question, "how many t-cells would rawtop need to get to before initiating HAART?"...but u left my first threshold question unanswered, so i'll ask in terms of broadest consensus: if the START trial shows conclusively that initiating HAART when t-cells r above 500 produces the best health outcomes, would u still avoid doing so if u were poz? would u still advise others to do so? i submit that at THAT point u would in fact be wearing a tin-foil hat.

i'm certainly curious about ur detailed response, but i wonder if i should ask certain questions privately...

Let me see...Rawtop says don't start meds too early, my Doctor says start right away....mmmmm? not sure who I should listen too.

with all due respect, and as someone who disagrees quite substantially with RT's position, i must note that ur analogy is overly simplistic. ur doc by default has primary authority (beside YOURSELF) over ur healthcare, but HIV/AIDS more than any other ailment has paved the multi-lane path for patients, stakeholders and lay persons to join the debate. the family of retroviruses has proven far more wily than any single human can grasp, let alone counter. every reasonably informed opinion counts.

[rawTOP]

Let me see...Rawtop says don't start meds too early, my Doctor says start right away....mmmmm? not sure who I should listen too.

Let's see... One of the top neurologists in the world (the chair of neurology at MSKCC) insisted I had a brain tumor when it was a scar. Even _after_ two biopsies both said it was just scar tissue. She literally discounted the results of 2 biopsies that were done by one of the top neurosurgeons in the world (the chief of neurosurgery at MSKCC). The second biopsy was incredibly aggressive - you can still feel the hole in my head from it nearly a decade later. After all that, I've earned the right to be skeptical of doctors (not to mention seeing a lover die in part because of overly-aggressive treatment). I even asked her whether the "growth" she was seeing was due to MRI technology showing more and more detail over the years. She was wrong, the radiologist and public university-educated neurologist were right. My hunch about MRI technology improvements looking like growth were right as well. God gave me a brain - I intend to use it and not just accept what I'm told.

You should never do something serious health-related without getting a second and possibly third opinion. Doctors are often wrong and in an era of drug reps giving free meals and vacations to doctors that prescribe and malpractice insurance companies telling doctors they won't get sued for doing too much - only for doing too little - you really do need to question your doctor's advice - especially on the big stuff like "take these pills for the next 50 years".

[Guest Porthos]

I'm not a doctor, I'm an architect, but a reasonably educated person who has become very well informed through my doctor and his entire staff at the ID department at my local medical center. This includes other doctors, pharmacologists, researchers and physician assistants. The evidence is becoming overwhelming that starting early is beneficial. My somewhat sarcastic comment stands. Rawtop's comments are simply anecdotal and based on his experience, not on the best recommendations from the scientific community.

[rawTOP]

but u left my first threshold question unanswered, so i'll ask in terms of broadest consensus: if the START trial shows conclusively that initiating HAART when t-cells r above 500 produces the best health outcomes, would u still avoid doing so if u were poz? would u still advise others to do so? i submit that at THAT point u would in fact be wearing a tin-foil hat.

Personally, yes, I'd wait. The issue is that the study can't be conclusive 'cause it can't tell me what the drug side effects will be in 30, 40 or 50 years - it will always inherently be an incomplete study. So if they give me a range - I'll pick the edge of the range that keeps me off drugs the longest.

And yes, I'll continue to point out what's missing from the studies. What they're not saying. What they can't promise you. And what the backroom, big-money antics might be that are influencing the recommendations. That's not tin foil hat - that's just observation. One of the principles of science is that you understand the assumptions that go into your conclusions - that's really all I'm doing.

I didn't even go into my brother-in-law's case... He was diagnosed bipolar a while after my sister married him and they put him on some powerful drugs that never quite worked properly. Then at one point he and my sister sat me down to tell me he was "bisexual". To me that sorta explained his bipolar issues - he wasn't at peace with who he was and the internal turmoil was causing him big problems psychologically. Rather than dealing with the underlying issue (his homosexuality) they gave it the fashionable diagnosis of the day and tried to medicate the problem away. Then, after years of powerful drugs he got diagnosed with Parkinson's. Conveniently Parkinson's is one of those illnesses that you can't prove with a lab test. Personally I think what they interpreted as Parkinsons were the effects of the meds he had been taking for years. Then they started giving him more meds to deal with the side effects of his Parkinson's meds. He takes something like 30 pills a day now and is a complete basket case. Honestly I think he'd be living a healthy happy productive life if he had just come out all those years ago and lived his life as an openly gay man. It's really pretty sad.

I know that's all speculation - but try and prove me wrong. I keep seeing bad things happen (medically) to people who aren't at peace with who they are. It's not pharma related but one of my bf's best friends died of breast cancer after being in a rather hostile corporate environment. On so many levels your inner chi is incredibly important. People who are at peace with themselves tend to die of rather ordinary and boring things...

Moderation and inner peace... I'll take that over aggressive medication any day... And if I die a little early - so be it - I had a good life.

[rawTOP]

Rawtop's comments are simply anecdotal and based on his experience, not on the best recommendations from the scientific community.

Ah... You should have heard the discussion of hormones in animal feed that my sisters had... One is a scientist with a Ph.D. in animal nutrition. The other had a daughter go into puberty at the age of 9 because the artificial hormones in the meat she was serving her kids. When she cut out things like Purdue chicken her daughter went back to normal for a girl of her age.

Or ask yourself where the epidemic of autism is coming from... I'd almost put money on it being caused by something that scientists say isn't known to be harmful.

At the same time I completely respect science. But science has practical limits and sometimes it takes a while for scientists to see the full picture.

[rawTOP]

I'm not a doctor, I'm an architect, but a reasonably educated person who has become very well informed through my doctor and his entire staff at the ID department at my local medical center. This includes other doctors, pharmacologists, researchers and physician assistants. The evidence is becoming overwhelming that starting early is beneficial. My somewhat sarcastic comment stands. Rawtop's comments are simply anecdotal and based on his experience, not on the best recommendations from the scientific community.

Getting second opinions from people at the same institution is generally a bad idea. For second and third opinions it's best to go to a doctor who is completely unconnected to the original doctor. I've seen it in action - if they know and respect the other doctor they won't contradict the diagnosis - even when it's wrong.

[TonyRedux]

per the abominable Godfather 3, I KEEP TRYING TO GET OUT, BUT THEY KEEP PULLING ME BACK IN!!@!

rawtop, ur correct that docs at the same institution will commonly back each other up, and that big pharma wields gross and insidious influence in medical decision-making at all levels, and that science is by definition never holistic, always materialistic and concerned with testability and repeatability. i was also raised in a martial arts household where i was taught to feel, nurture and respect chi, within and without.

nonetheless, some of ur comments here could easily be used to script portrayals of mid-80's New Age healthcare charlatans who told a long stream of AIDS patients that the illness was essentially their fault for not being "balanced within"...so i'm curious as to how u firewall ur comments from being interpreted to that extent. to this day i know of HIV doctors in NYC who believe (and tell their patients) that even tho Federal guidelines advise starting meds when t-cells fall below 500, they themselves believe that it's still credible to consider waiting until their t-cells fall below **200**.

y do u concur with the current consensus that 350-500 t-cells is the "sweet spot" for starting therapy, yet refuse to change ur assessment if the consensus shifts to above 500? why isn't the 350-500 "sweet spot" tainted by Big Pharma in ur eyes?

[Guest]

Yes Pharm companies make a ton of money. Yes they can influence doctors. I think those facts shouldn't hold too much weight because the first step begins with the right doctor.

Every single person in this world is different. Treatment should be calculated on a case by case situation. Let's throw out the idea of pharm companies making billions and pushing their products. We don't need to drink red bulls, drink alcohol or smoke, we know it's bad for us. But since there is a market out there to consume these goods, there will be marketers to push it. Products will be pushed, that is a give in. Now put that fact aside and think about the main issue in controversy. I've had many friends who became poz and their doctors did not put them on any medication until it was necessary.

To my own experience and collection of stories from folks I know, this is the usual course I have seen. We can only assume that perhaps a doctor who isn't well experienced in dealing with HIV patients may put someone on meds immediately. A doctor may go the route of being influenced by the pharm companies' marketing push, who knows? We can only speculate. We can't examine each and everyone's situation. Side effects are always going to be an occurrence that goes hand in hand with any type of medication. I just hope that people who do seek treatment for their HIV find the best possible doctor that can formulate the right course of action for that particular person.

[GermanFucker]

@GermanFucker & Tony... You're both ignoring the effect of the pharma industry on the research and discounting the long-term side effects 20, 40+ years from now. I mean doctors put people on meds before they even know whether the person is genetically able to suppress HIV. What pharma affiliations do the researchers of those studies have? Do you know? It makes a huge difference. Seriously...

While you ignore the effect 10 or more years of uncontrolled HIV have on the body. I agree that in the end it should be an informed decision made by the patient and he should here all aspects of the argument. However I do believe your propetia analogy is misleading, as it is a.) not really that pertinent to the question and b.) not really based on hard facts.

I admit that maybe I am slightly biased and therefore maybe slightly emotional about the issue. As I mentioned before a good friend of mine got cancer as a result of the damage HIV did to his system and just barely survived. Early treatment most likely would have benefited his quality of life, his long-term health and would have saved him weeks in the hospital.

As to your brain tumor scare: Yes, there are bad doctors, and yes, there always is the risk to be the one exception that proves the rule. That doesn't mean one should ignore facts to fit one's preconceived notions. If I'm with Tony on this it is because right now empirical data points in that direction.

I once talked to an alternative / tin-foil hat mom who tried to convince me that vaccinations are bad because one out of every thousand kids got serious side effects / lasting damage (not true BTW). I answered: Well, great, measles KILL about that many, it's always better to survive, isn't it? She went apeshit. She simply couldn't handle her prejudices being challenged. A hopeless case. My point is: when weighing different arguments on the issue, you also have to look at the background to assess their value:

activist vs. specialist

analogy vs. pertinent information

potential risk vs. known damage

speculation vs. empirical data

P.S.: Being at peace with oneself is the basis of well-being, that doesn't mean that it alone is always enough.

[rawTOP]

nonetheless, some of ur comments here could easily be used to script portrayals of mid-80's New Age healthcare charlatans who told a long stream of AIDS patients that the illness was essentially their fault for not being "balanced within"...so i'm curious as to how u firewall ur comments from being interpreted to that extent.

You know me... I'm far too much of a hard-nosed New Yorker to believe that medicine is irrelevant. At the same time having a doc tell you to go on meds for 20 to 60 years is a decision that requires close examination and people shouldn't be criticized for saying "I'll wait".

to this day i know of HIV doctors in NYC who believe (and tell their patients) that even tho Federal guidelines advise starting meds when t-cells fall below 500, they themselves believe that it's still credible to consider waiting until their t-cells fall below **200**.

y do u concur with the current consensus that 350-500 t-cells is the "sweet spot" for starting therapy, yet refuse to change ur assessment if the consensus shifts to above 500? why isn't the 350-500 "sweet spot" tainted by Big Pharma in ur eyes?

Honestly, I'm not poz and if I became poz I'd research things more carefully and make my own decision. Everything I've learned over the last 25 years tells me that going on meds quickly is not something I'd want to do personally. I can't say whether it's 200 or 350. I know I would be more concerned about sustained trends than I would be about a temporary spike/drop. I'd want to see repeated tests at the threshold level to go on meds.

Honestly though - I've been around the block enough to know where those doctors who say "under 200" are coming from. They come from the same school of thought as the social worker who observed that the less you do, the better the outcome. They've been around long enough to know the dangers of aggressive treatment. I respect that. And I'd bet those same docs aren't dogmatic about what they advise - they lay things out and let the patient figure out what's right for them. To me, that's good medicine.

...the first step begins with the right doctor.

I've seen to many "top doctors" do stupid things - things that hurt, rather than help their patients. I've seen that the average doctor will refuse to contradict the opinion of "top doctors". Finding "the right doctor" is like finding a needle in the haystack - more often than not you don't wind up with the right doctor - you wind up with one that's just "good enough" (even when you think you have a good doctor).

As to your brain tumor scare: Yes, there are bad doctors, and yes, there always is the risk to be the one exception that proves the rule. That doesn't mean one should ignore facts to fit one's preconceived notions. If I'm with Tony on this it is because right now empirical data points in that direction.

I've seen bad doctors over and over and over. Bad doctors are the rule, not the exception. It's one of those "fool me once, shame on you - fool me twice, shame on me" scenarios. I now think for myself and on major stuff I stop and consider their recommendation and see if it's right for me.

I once talked to an alternative / tin-foil hat mom who tried to convince me that vaccinations are bad because one out of every thousand kids got serious side effects / lasting damage (not true BTW). I answered: Well, great, measles KILL about that many, it's always better to survive, isn't it? She went apeshit. She simply couldn't handle her prejudices being challenged. A hopeless case. My point is: when weighing different arguments on the issue, you also have to look at the background to assess their value:

Your tin foil hat mom is actually close to the truth. Vaccines are one of the leading theories for the dramatic rise of autism. However sensible folk aren't against vaccines all together - instead they want to tweak the timing of vaccines. Some vaccines can be given a little later, when the child's body is a bit more mature and that delay means there's far less side effects. Case and point - I went to military doctors my entire life. When I was a teen it came out that a certain vaccine could be dangerous if given to children too early. My mom looked at my vaccine record and saw that military doctors knew (or suspected) the danger 10+ years before the general public and had delayed giving me that particular vaccine. That's not tin foil hat - it's prudent medicine.

P.S.: Being at peace with oneself is the basis of well-being, that doesn't mean that it alone is always enough.

Of course.

[HungLatinDom]

A year ago, I would have disagreed more strongly with RawTop. Now, after seeing all the Vioxx drama and how Merck behaved, I think he has a point, however, I still would take the side effects of the ARV as opposed to unchecked damage by the virus. The thing is that I cannot in my current situation.

[HungLatinDom]

The research that linked autism with vaccines has been completely debunked and the doctor that started it has proven to be involved in unethical behavior and had interest conflicts before publishing the papers. http://en.wikipedia.org/wiki/Andrew_Wakefield#Fraud_and_conflict_of_interest_allegations

Not sure how much of the increase in autism rates is just that kids that were odd twenty years ago now get diagnosed as autistic. ANd the overdiagnosis is another feature of the pharma overreach too.

[tin]

One of the big reasons for encouraging early treatment is to help prevent the spread of HIV. Outside of a few niche forums - this is generally seen as a good thing. Even RT has pointed to studies showing that 'people on HAART with undetectable viral load are at negligible risk of transmission.'

Also, for most people - even if toxicity effects occur in 30 or so years - without meds, they would be in far worse health than before then.

I am aware that everyone reacts differently to HIV. Me and my partner became poz at around the same time. After a year on meds, my CD4 count has seemingly stabilized at around 350 for some reason. My partner? no meds - and his CD4 count is 900 - but his viral load is getting high.

There will come a point of which my doctor may put him onto meds regardless of CD4 count, as the virus if left to it's own devices - can be damaging to the body anyway by triggering the inflammatory response.

It still might be awhile yet before he gets puts onto medication. It's weird though - despite my lower CD4 count, my health is pretty much fine. My partner, he's been having issues lately - and we both can't help but wonder 'how much of this could be related to HIV and not being on meds yet?'

Now, lets say me and him break up - and he wants to enter the dating scene again. Most people don't want to get HIV, and most HIV+ people don't want to spread HIV - especially to potential HIV- partners. Again, this comes back as an 'early treatment to prevent the spread of HIV' - and really, I have a hard time as viewing this as a bad thing.

Or, take Average-Joe, that isn't a bug-chaser, isn't into gift giving/getting, HIV fetish, etc. He fucked up one night, didn't use a condom, or it broke - and finds himself HIV+. He wants to continue is generally 'conservative' sex life (ie: not many casual hookups, rather be dating/in a relationship). I can see why he would be inclined to start ARV therapy sooner rather than later. Not everyone views becoming HIV+ as a sexually liberating free-pass to all of the kinky anonymous bareback casual sex they always wanted but were too afraid to get.

So, between the desire to reduce a persons risk of transmission, and minimizing the inflammatory response of letting HIV run wild in your system - I can understand the desire to treat sooner rather than later.

I do agree with the notion of 'Each person needs to be considered individually to determine when to start meds' and not so much 'start them the moment that they find out they are poz'. Factors such as how their body handles the virus, and what they are doing in the rest of their lives that could impact it. ie: I just found out I'm poz, my CD4 count is great - I generally would put off going on meds, but I just started dating an HIV- person and want to reduce my risk of transmission.

It seems like medications are getting to the point where the long-term harm of going on medications sooner rather than later, is out-weighing the potential long term harm of letting HIV go untreated.

Edited January 10, 2012 by tin